Clinical skills and professional development are major curricular focuses that span all four years, providing early patient exposure and the means to develop outstanding clinical thinking, technical skills, and professionalism attributes. Substantial curricular time is devoted to clinical skills and reasoning activities and student professional development. Such activities are integrated into the Practice of Medicine course offered across the Fundamentals of Medicine curriculum.
Students meet at least weekly in small groups as they work with clinical faculty to apply interview and examination skills to diagnosis and treatment. These activities provide focused learning opportunities through cooperation and collaboration, which helps students develop their abilities to work with groups of colleagues and co-workers in a professional environment. Further, the small group activities involve active learning focusing on problem-solving, interviewing, and physical exam skills. Central to all components is the concept of professionalism and the integration of biomedical and psychosocial concepts of patient care.
The Practice of Medicine course includes seven major components:
- 1. CLINICAL APPRENTICESHIP PROGRAM (CAP):
The Clinical Apprenticeship Program (CAP) emphasizes early clinical learning by matching first-year students with clinical preceptors. Soon after the Foundations course, each student is assigned to a physician to complete a clinical apprenticeship in the physician’s office throughout the preclinical phase of the curriculum. During this time, students have an opportunity to observe the practice of medicine and begin to integrate what they are learning in the other segments of the curriculum.
- 2. CLINICAL INTEGRATION SESSIONS (CIS):
Clinical integration sessions (CIS) are case‐based, small-group workshops that serve to integrate history and physical exam skills with clinical reasoning to learn how to diagnose and care for patients. Cases are coordinated with information learned in the organ system-based blocks and with the remaining curricular themes. Students will use clinical reasoning and clinical problem-solving skills, as they examine common diseases and disorders. CIS sessions are led by clinical faculty, with whom students work regularly during the entire curriculum.
- 3. INTERVIEW SESSIONS:
In the interview sessions, small groups and faculty will work on introductory and then advanced history‐taking and communication skills. Some of these sessions will be co‐led by instructors and psychosocial educators who have expertise in interviewing and counseling patients.
- 4. PHYSICAL DIAGNOSIS SESSIONS (PDX):
Physical Diagnosis Sessions occur in our Clinical Learning and Simulation Skills (CLASS) Center and are led by standardized patient instructors as well as fourth-year medical student peer instructors. After students achieve proficiency in a core physical exam during the Foundations course, students will learn to use physical examination during each block as a clinical reasoning strategy to make appropriate diagnoses. Physical diagnosis sessions occur about once a month in the early evenings.
- 5. FORMATIVE OBSERVED SIMULATED CLINICAL EXPERIENCE (FOSCE):
The Formative Observed Simulated Clinical Experience (FOSCE) sessions, which are led by Practice of Medicine instructors, serve as an opportunity to work in a simulated environment, allowing students to integrate the practice of history‐taking, physical exams, and clinical reasoning skills in a series of standardized patient cases. Students will use information obtained from standardized patients’ history and physical exams to create differential diagnoses and order appropriate diagnostic testing, ultimately leading to the correct diagnosis.
- 6. INFORMATICS SESSIONS
With advances in information technology, informatics has become an important clinical skill. Library faculty work with small groups of students to teach skills in finding high‐quality medical information and assist them in critically evaluating sources.
- 7. COACHING PROGRAM
Coaching is a longitudinal program over the course of the entire 4-year medical school journey. Students are coached to self-direct their learning by recognizing gaps, implementing goals to address them, and tracking change via objective and subjective tools. The Master Adaptive Learning (MAL) model is used to structure this process of growth and professional identity formation.
Clinical Skills in the Fundamentals of Clinical Practice Phase
At the beginning of the Fundamentals of Clinical Practice, students will enroll in a two week-long Foundations of Clinical Practice course that focuses on enhancing clinical skills—including procedures—to prepare students for ward rotations. Throughout the Fundamentals of Clinical Practice phase, students will also participate in a Longitudinal Primary Care Clinic (LPCC) that complements the Primary Care Clerkship. Students will work 10 half-days over a period of 24 weeks in a primary care setting (general internal medicine, general pediatrics, family medicine, or geriatrics) regardless of their current rotation.
Clinical Skills in the Transitions to Advanced Clinical Practice: The Capstone Course
The Transition to Advanced Clinical Practice phase includes an intensive, one-month capstone experience involving refining many technical skills and reinforcing essential clinical competencies. Students are grouped by future specialty for much of this course, receiving direct mentorship from faculty physicians in their specialty. The course extensively uses the CLASS Center with a focus on simulation training. The course’s primary objective is to prepare students to perform at a high level as they transition to their residency.
Clinical Learning and Simulation Skills Center (CLASS Center)
SMHS’s educational facilities are at the forefront of academic medicine and give SMHS students a decided edge over their counterparts in programs at other institutions. The CLASS Center provides one of the most innovative educational environments in the nation. Students supplement their classroom learning with comprehensive clinical exposure, feedback, and evaluation that prepare them to become technically adept and compassionate caregivers.
The 17,000-square-foot CLASS Center is located on the fourth floor of Ross Hall. The facility features some of the most innovative simulation, standardized patient, and learning/convening spaces available. The CLASS Center has 12 outpatient and two inpatient examination rooms for standardized patient encounters, as well as a labor and delivery suite; two mock operating theaters; two high-fidelity rooms; cutting-edge medical simulators, including full-body computerized manikins and surgical trainers; and laboratory space for procedural skills training.
Using simple anatomic models, students can learn the basics of a procedure, such as IV placement or resuscitation of a critically ill patient. More advanced trainees can transition to high-fidelity simulators, where students practice diagnostic skills, integrate previously learned procedures into patient care, and improve teamwork and communication skills.
A sophisticated data system allows curricular content to be pushed from a control room to any 32 screens mounted throughout the CLASS Center. X-ray images, footage of real patients, and technique demonstrations are just a few types of content that can be displayed to students working in the center.
Like the practice of medicine itself, simulation has both a human side and a technological side. The human side is embodied by standardized patients (SPs), who play the part of patients suffering from any number of medical maladies. Through face-to-face interaction with SPs, students can perfect their skills in history-taking, physical exams, and communication.